Her health.

Oral Contraceptives' Safety Lauded, But Concerns Linger

One report deems the pill is safe. Another says it may cause cancer. Questions about the pill's safety have been batted back and forth for decades.

The good news is that oral contraceptives probably are a lot safer than we think. This should be reassuring given that the pill is the most popular non-permanent method of birth control in this country. According to a 1992 survey by Ortho Pharmaceuticals, a maker of the pill, 18.7 million women take oral contraceptives, more than double the number in 1981.

Despite the pill's high rate of acceptance by women, the question of safety remains. Perhaps we remember the reports linking the older, high-octane tablets, which contained 80 to 150 micrograms of estrogen, with an increased incidence of blood clots, strokes and heart attacks. Or perhaps we've heard that today's kinder, gentler pills (of up to 50 micrograms) are not entirely without risk.

Take heart disease. Pill users who smoke have a greatly increased rate of heart attack and blood clots in the brain, which could lead to stroke. Experts agree that women who smoke or who are predisposed to cardiovascular disease should not be on the pill. For non-smoking pill users the risk of developing a blood clot is negligible: only 3 or 4 in 10,000 versus 2 in 10,000 for non-pill users. Some suspect low-dose pills may offer non-smokers protection against heart disease.

What about breast cancer? "In 30 years of use, no study has shown the pill increases your lifetime risk of developing breast cancer," says Dr. Kirtly Parker Jones, an associate professor of obstetrics and gynecology at the University of Utah Medical Center in Salt Lake City.

While the pill is not recommended for women who have had breast cancer, the landmark Cancer and Steroid Hormone Study, conducted in the early '80s by the Centers for Disease Control and Prevention, showed that women between the ages of 20 and 54 "had no increase or decrease in breast cancer risk associated with the pill," says Phyllis Wingo, chief of the centers' Fertility Epidemiology Section.

Several studies have suggested that the pill may be associated with a 10 percent to 60 percent increase in the risk of breast cancer for women diagnosed before age 35. However, breast cancer is rare in young women. A report by the non-profit Alan Guttmacher Institute says these numbers translate into an extra 7 to 9 cases of breast cancer for every 100,000 women in their 30s.

Studies also have linked the pill with liver cancer. But again, liver cancer only strikes 1 to 2 of every 100,000 women. Still, women who have liver disease should not be on the pill. Nor should those who have severe migraines, high blood pressure or diabetes.

If the risks of oral contraceptives among non-smoking women are negligible, the benefits are striking. Not only is the pill 97 percent to 99 percent effective in preventing pregnancy, the cancer and steroid study shows that it has life-preserving effects. For instance, the risk of developing ovarian and endometrial cancers is reduced by half for women who have been on the pill for at least one year. "This is cancer prevention," notes Dr. David Grimes, a professor of obstetrics and gynecology at the University of California at San Francisco.

In addition, the pill regulates menstrual cycles and may reduce symptoms of premenstrual syndrome.

Oral contraceptives may provide added benefits to older women. Once considered a health risk for women over 40, the pill can be safely used until menopause, the Food and Drug Administration ruled in 1990. "As a woman approaches menopause, she stops making an egg every month, which results in unpredictable and heavy bleeding," says Grimes.

The non-profit National Women's Health Network is less than thrilled. "A woman could be on hormones from age 13 to death, and that seems like a lousy idea," says Dr. Adriane Fugh-Berman, a network board member. The group is advising its members not to take the pill past age 40.

For the free brochure "Oral Contraceptives," send a self-addressed, stamped, business-size envelope to the American College of Obstetricians and Gynecologists, Resource Center, 409 12th St. S.W., Washington, D.C. 20024-2188.